Abnormal LFTs: When Should You Be Concerned?

Liver plays a crucial role in our body's overall health—it helps process nutrients, filters toxins, produces bile for digestion, and supports metabolic functions. When something goes wrong with the liver, it may not always show obvious symptoms right away. That’s where Liver Function Tests (LFTs) come in.

LFTs are a group of blood tests used to assess the health and functionality of your liver. But what does it mean when your LFT results are abnormal? Is it always serious? Let’s break down what abnormal LFTs mean, possible causes, and when you should be concerned.

What Are Liver Function Tests (LFTs)?

Liver function tests are a panel of blood tests that check for:

Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST)
Alkaline Phosphatase (ALP)
Gamma-glutamyl transferase (GGT)
Bilirubin (Total and Direct)
Albumin and Total Protein

Each of these markers gives a snapshot of different aspects of your liver’s condition—whether it’s inflamed, injured, or under stress.

What Do Abnormal LFT Results Indicate?

An abnormal LFT means that one or more of these markers are outside the normal range. This doesn’t automatically mean you have liver disease—it simply flags that your liver might be stressed or impaired. Understanding which values are abnormal helps in narrowing down the cause.

Let’s look at the most common markers and what abnormal levels might mean:

1. ALT and AST (Transaminases)

These are enzymes released when liver cells are damaged. Elevated levels often point to:

Hepatitis (viral, alcoholic, or autoimmune)
Fatty liver disease (NAFLD or NASH)
Drug-induced liver injury
Liver cirrhosis

If ALT is higher than AST, it may suggest non-alcoholic fatty liver disease (NAFLD). If AST is higher than ALT (especially more than twice), alcoholic liver disease is more likely.

2. Alkaline Phosphatase (ALP)

This enzyme is found in the bile ducts and bones. Elevated ALP levels might indicate:

Bile duct obstruction (like gallstones)
Liver tumors
Liver cirrhosis
Bone diseases (like Paget’s disease or bone metastasis)

3. Gamma-Glutamyl Transferase (GGT)

GGT is particularly useful when both ALP and GGT are elevated—it suggests a bile duct problem or alcohol-related liver damage.

4. Bilirubin

Bilirubin is a yellow pigment formed during the breakdown of red blood cells. High bilirubin levels cause jaundice (yellowing of skin and eyes) and may suggest:

Hepatitis
Hemolytic anemia
Liver cirrhosis
Blocked bile ducts

5. Albumin and Total Protein

Low albumin may point toward chronic liver disease, kidney disease, or malnutrition. The liver produces albumin, so lower levels over time can suggest long-term damage.

Common Causes of Abnormal LFTs

There are many possible causes of liver function abnormalities. Some are harmless or temporary, while others require immediate attention.

Fatty Liver Disease:
Linked with obesity, insulin resistance, diabetes, and high cholesterol.
Alcoholic Liver Disease:
Chronic alcohol use raises AST and GGT; long-term can lead to cirrhosis.
Viral Hepatitis:
Hepatitis A, B, and C commonly cause high ALT/AST levels.
Medications and Toxins:
Drugs like paracetamol or statins, and some supplements, can stress the liver.
Autoimmune Liver Disorders:
Includes autoimmune hepatitis, PBC, and PSC.
Liver Tumors or Metastasis:
May show elevated ALP and GGT.
Blocked Bile Ducts:
Gallstones or bile duct narrowing spike ALP, GGT, and bilirubin.

When Should You Be Concerned?

Not every abnormal LFT needs urgent medical attention, but some patterns or symptoms demand further investigation.

Symptoms That Require Medical Attention:

Jaundice (yellowing of skin/eyes)
Severe fatigue or weakness
Unexplained weight loss
Persistent nausea or vomiting
Abdominal pain or swelling
Dark urine or pale stools
Swelling in the legs (edema)

High-Risk Groups Who Should Monitor LFTs Closely:

People with diabetes or obesity
Those with a family history of liver disease
Individuals who consume alcohol regularly
Patients on long-term medications that can affect the liver
People with HIV, hepatitis B or C

What to Do If Your LFTs Are Abnormal

Don’t panic:
Slightly elevated levels are common and can be due to recent illness, medications, or even strenuous exercise.
Consult a Doctor:
Your doctor will interpret the results based on your medical history, symptoms, and medications. They may recommend additional tests like:
- Ultrasound or CT scan
- Viral hepatitis panel
- Autoimmune antibody tests
- Liver biopsy (in rare cases)
Make Lifestyle Changes:
In many cases, LFTs normalize with lifestyle changes like:
- Reducing alcohol intake
- Losing weight
- Controlling blood sugar and cholesterol
- Avoiding over-the-counter medications without supervision
Repeat the Test:
Your doctor may suggest repeating the test after a few weeks to see if the abnormality persists or resolves on its own.

How Often Should You Get LFTs?

Routine LFTs may be recommended:

Annually for people with risk factors (obesity, diabetes, alcohol use)
More frequently for individuals on medications affecting the liver
As advised if you have liver disease or symptoms

Role of Preventive Screening

Preventive health checkups that include LFTs can help catch issues early—before symptoms appear. Early detection means early treatment and a better outcome.

Modern diagnostic labs offer comprehensive liver health panels as part of regular health checkups. These tests are quick, accurate, and often available with home sample collection services for your convenience.

Conclusion

Abnormal LFTs are not a diagnosis in themselves—they're a clue that something might need attention. While a single abnormal result might not be alarming, persistent or significantly abnormal values should never be ignored.

If you’ve recently received abnormal LFT results, talk to your doctor, and consider scheduling a follow-up. With the right care and lifestyle changes, most liver issues can be managed or even reversed.